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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-3444

2. Registrant Information.

Registrant Reference Number: 1009483

Registrant Name (Full Legal Name no abbreviations): Bayer CropScience Inc.

Address: 295 Henderson Drive

City: Regina

Prov / State: SK

Country: Canada

Postal Code: S4N 6C2

3. Select the appropriate subform(s) for the incident.


4. Date registrant was first informed of the incident.


5. Location of incident.

Country: CANADA


6. Date incident was first observed.


Product Description

7. a) Provide the active ingredient and, if available, the registration number and product name (include all tank mixes). If the product is not registered provide a submission number.


PMRA Registration No. 29821      PMRA Submission No.       EPA Registration No.

Product Name: Prosaro 250 EC Fungicide

  • Active Ingredient(s)

7. b) Type of formulation.

Application Information

8. Product was applied?


9. Application Rate.


10. Site pesticide was applied to (select all that apply).

Site: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: Unspecified

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding application.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?


Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.


2. Demographic information of data subject

Sex: Male

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.


  • General
    • Symptom - Chills
    • Symptom - Diaphoresis
    • Symptom - Fever

4. How long did the symptoms last?

Unknown / Inconnu

5. Was medical treatment provided? Provide details in question 13.


6. a) Was the person hospitalized?


6. b) For how long?

7. Exposure scenario


8. How did exposure occur? (Select all that apply)


9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

Long-sleeve shirt

Long pants

Chemical resistant gloves

10. Route(s) of exposure.


11. What was the length of exposure?

<=15 min / <=15 min

12. Time between exposure and onset of symptoms.

>8 hrs <=24 hrs / > 8 h < = 24 h

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

July 18, 2012 Father of patient calling regarding his son who developed an illness consisting of cycling fevers and child starting on July 15. On July 12, 2012 the son had applied diluted herbicide to about 1500 acres using a high clearance sprayer and a chemical handler. The cab of the tractor was completely enclosed and had charcoal filtration air filters. The patient also wore a long sleeve shirt and long pants as well as rubber gloved. The son does not recall any instance of product exposure during the application. It was warm the day of the application with temperatures around 30 degrees Celsius. The son was planning on seeing a physician soon. Follow-up on August 15, 2012. The patient continues to suffer from recurring fevers. He was diagnosed with an infection involving chromobacterium violaceum in July. He had recently completed a course of antibiotics and will be continuing to follow-up with his doctors. The treating doctors suspect the patient acquired this infection while he was vacationing in Cuba last February. The role of the fungicide has been completely ruled out.

To be determined by Registrant

14. Severity classification.


15. Provide supplemental information here.